Flashcards in P10 - Pulmonary pathology Deck (56)
What are clinical presentations of lung disease?
• Cough, wheeze
• Breathlessness (dyspnoea)
• Chest pain (often due to pleural disease)
Are the lungs themselves sensitive to pain?
No- but the chest wall is
What are the 2 functional classifications of lung disease?
Describe obstructive lung disease.
Normal volume but difficulty getting air out (asthma)
Describe restrictive lung disease.
Decreased lung volumes (scarring /fibrosis in lungs)
Name 5 ways of investigation of a patient with lung disease.
• Chest x-ray +/- CT scan
• Hb, white cell count etc
• Arterial blood gases (pO2, pCO2, pH)
• Physiology (spirometry, pulmonary function tests)
• Bronchoscopy +/- biopsy and lavage
what is the lungs function?
to facilitate transfer of O2 to blood and CO2 in the other direction
What is type 1 respiratory failure?
decreased arterial pO2
What is type II respiratory failure?
decreased arterial pO2 plus increased arterial pCO2
which is worse of the two respiratory failures?
Type II - pulmonary function is terminal
What does decreased Pa O2 lead to?
• Dyspnoea and increased respiratory rate
• Pulmonary vasoconstriction (and pulmonary
• Eventually right sided heart failure
What can cause airway narrowing /obstruction?
• Muscle spasm
• Mucosal oedema (inflammatory or otherwise
• Airway collapse due to loss of support
• (Localised obstruction due to tumour or foreign body)
What are the main categories of obstructive disease?
• Chronic obstructive pulmonary disease (COPD/COAD/COLD)
What is bronchial asthma?
A chronic inflammatory disorder characterised by hyperreactive airways leading to episodic reversible bronchoconstriction
What is extrinsic asthma?
response to inhaled antigen
What is intrinsic asthma?
non-immune mechanisms (cold, exercise, aspirin)
What is type I hypersensitivity ?
Allergen binds to IgE on surface of mast cells
what effects does type 1 hypersensitivity have?
• Degranulation (histamine)
– muscle spasm
– inflammatory cell influx (eosinophils)
– mucosal inflammation/oedema
• Inflammatory infiltrate tends to chronicity
Name the types of pathology.
• Narrowed oedematous airways
• Mucus plugs
• Inflammatory cells (lymphocytes, plasma cells, eosinophils)
• Epithelial cell damage
What is mucosal oedema?
airways narrowed and blocked by mucous
Name 2 types of chronic obstructive disease.
• Chronic bronchitis
what do symptomatic patients have?
Often have both chronic bronchitis and emphysema
What is the epidemiology of COPD?
• Atmospheric pollution
• Genetic factors
what is the epidemiology definition of chronic bronchitis?
Cough productive of sputum on most days for 3 months of at least 2 successive years
what does chronic bronchitis not imply?
What is emphysema?
• Increase beyond the normal in the size of the airspaces distal to the terminal bronchiole
• Without fibrosis
-The gas-exchanging compartment of the lung
What is emphysema due to?
“Dilatation” is due to loss of alveolar walls (tissue destruction)
• Appears as “holes” in the lung tissue
Discuss the diagnosis and treatment of emphysema.
• Difficult to diagnose in life (apart from in
• Radiology (CT) can show changes in lung
• Correlation with function known from autopsy studies
what is panacinar emphysema?
Tissue destructtion-extreme -big dilated airspaces, loss of tissue between gives illusion of dilation